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Sleep Disordered Breathing

It is a complex breathing condition that interferes with your sleep pattern and your health in two prominent ways:

Sleep Fragmentation – Disruptive as it interferes with your brain waves when you attempt to sleep. You also do not stay in a deep sleep, but rather restorative stages of sleep for most of the night. SDB forces you into lighter sleep stages that trigger hundreds of small awakenings that rob you of your sleep. If you sleep for 8 hours and suffer from SDB (moderate to severe) you will only get 4 -6 hours of solid sleep.

Oxygen fluctuations – Alters the stability of oxygen levels your body receives and transfers into the bloodstream. Patients with SDB have fluctuating oxygen levels all night long, within a timespan as short as a few seconds. In a 30 second interval, oxygen can start at 94% drop to 91 in 10 seconds, and up to 93% in another 5 seconds, then drop to 89% in another 15 seconds. In severe cases it can deteriorate into desaturations where the oxygen levels drop between 90% for 10, 20, and 30 seconds or longer, before returning to the normal level above 90%. Oxygen levels can drop even lower, in REM sleep or when sleeping on your back.

SDB consists of more than a series of sleep apnea events, which is similar to a choking episode, where you stop breathing, from inhaling a piece of food into your windpipe for example. This may cause intense fear and panic in most people that will bring them to absolute alertness to solve the problem and fast. This happens with SDB when the airway closes down and all breathing stops. SDB may include a range of sleep breathing events where you can stop breathing, as well as your effort to breathe in gets compromised.

Frequently Asked Questions

1What are the two most common events than apneas in patients with SDB?

2Is UARS seen as Mini suffocations?

3Is UARS mutually exclusive of hypopneas or apneas?

4Is UARS assessment and treatment is critical to titration success?

5Can you feel anxiety in your sleep?

Hypopneas – Instead of a complete stopping in breathing, you lose about 50% of your normal breath, which can trigger sleep fragmentation and cause your oxygen to fluctuate or desaturate.

Flow Limitation – The airway experiences resistance, which is difficult to quantity, with a 10% reduction. There is a small reduction in breathing but can still trigger sleep fragmentation and oxygen fluctuations.

When suffering from SDB it can only be apneas, hypopneas or only flow limitations or in some cases a combination of all 3. When suffering only from flow limitations it may cause severe sleep fragmentation and oxygen fluctuations that damage your sleep along with your mental and physical health.

Sleep disordered breathing (apneas, hypopneas, UARS) is seen as some degree of suffocation. Apnea is the most common form as the patient awakens choking or gasping, and in UARS is equivalent to a mini suffocation, which when asleep produces an unpleasant sensation but not choking.

UARS is a more subtle form of breathing irregularity. It is not mutually exclusive of Hypopneas or apneas. One can have all 3 types of events when diagnosed with SDB. Almost all patients with OSA also have a UARS component on their diagnostic sleep studies.

Titration is performed and UARS is invariably present, as the pressurized airflow does not work like magic and suddenly make apneas appear. Apneas are sometimes turned into hypopneas when the pressure is increased, and then hypopneas are turned into UARS, also known as flow limitation.

Most patients want to switch bilevel during the desensitization before titration begins. If you can experience anxiety in dreams, then you can experience anxiety to pressurized airflow in your sleep. This is the reason why CPAP does not work well in patients with UARS, as well as SDB patients except for those who are hypersomnolent, anxiety free, sleep apnea cases.

Anxiety is present in most SDB cases, as it is anxiety-producing experience to breathe abnormally all night long. Anxiety and breathing are connected, and most SDB patients are more or less conditioned to be more nervous by having a night of struggling to breathe. CPAP triggers or worsens anxiety by introducing a foreign sensation – pressurized airflow forced inward during exhalation.